Schomburg A, Grünwald F, Schultes B, Hotze A, Bender H, Biersack H J
Department of Nuclear Medicine, University of Bonn, Germany.
Exp Clin Endocrinol Diabetes. 1996;104(2):123-9. doi: 10.1055/s-0029-1211433.
There is a lack (1.) of a single criterion for the definitive differentiation between immunogenic (IH) and non-immunogenic hyperthyroidism (NIH), and (2.) also a lack of an unequivocal prognostic predictor for the individual course of patients with immunogenic hyperthyroidism. In 152 patients scheduled for iodine-131 therapy, serum neopterin concentrations were measured using a commercially available RIA, and the neopterin concentrations of IH (n = 84) and NIH (n = 42) patients were compared. Of these patients, 83 and 26 per cent respectively were treated with antithyroid drugs which did not have a significant impact on neopterin levels. In patients with IH and NIH, the concentrations [mean +/- SD] of neopterin were 1.89 +/- 0.79 milligrams and 1.98 +/- 0.9 milligrams, respectively (p = 0.4). After therapy with iodine-131, 28% of the IH-patients were euthyroid, 32% hyperthyroid, and 40% hypothyroid. In finally euthyroid patients, pretherapeutic neopterin concentrations were higher (3.1 +/- 2.8 milligrams) than in finally hyperthyroid (1.8 +/- 0.7 milligrams), or hypothyroid (1.6 +/- 0.7 milligrams) patients. These results argue against a relevant clinical role of neopterin concentrations for the differential diagnosis of IH versus NIH in these patients. However, a prognostic significance of neopterin concentrations in patients with IH is suggested.
（1）缺乏用于明确区分免疫性甲状腺功能亢进（IH）和非免疫性甲状腺功能亢进（NIH）的单一标准，（2）也缺乏针对免疫性甲状腺功能亢进患者个体病程的明确预后预测指标。对152例计划接受碘-131治疗的患者，使用市售放射免疫分析法测定血清新蝶呤浓度，并比较IH患者（n = 84）和NIH患者（n = 42）的新蝶呤浓度。在这些患者中，分别有83%和26%接受了抗甲状腺药物治疗，这些药物对新蝶呤水平没有显著影响。在IH和NIH患者中，新蝶呤浓度[平均值±标准差]分别为1.89±0.79毫克和1.98±0.9毫克（p = 0.4）。碘-131治疗后，28%的IH患者甲状腺功能正常，32%为甲状腺功能亢进，40%为甲状腺功能减退。最终甲状腺功能正常的患者，治疗前新蝶呤浓度（3.1±2.8毫克）高于最终甲状腺功能亢进（1.8±0.7毫克）或甲状腺功能减退（1.6±0.7毫克）的患者。这些结果表明，新蝶呤浓度在这些患者中对IH与NIH的鉴别诊断没有相关临床作用。然而，提示新蝶呤浓度在IH患者中具有预后意义。
